What would a single payer system look like?

DoGoodThenGo · May 30, 2016

Are you stating that one day, there will be no such thing as individual freedom in the United States and providers will be forced to accept specific means of payment whether they want to do so or not?

Look, which side are you on anyway?

Force, leave as only option, make them an offer they cannot refuse... whatever you want to call it sometimes for the greater good things have to roll that way.

Many facilities aren't crazy about Medicare or Medicaid but yet it is nearly universally accepted. Private practice physicians are another matter, but again with more and more hospital owned practice and or large group networks like City MD that may become less of an issue in future.

You seem to want to play both sides of this debate, which just cannot happen. It is no good creating any sort of universal health care scheme where large numbers of providers refuse to accept.

NurseFifty · May 31, 2016

BC MSP claims it does send its heart patients to the US

NurseFifty · May 31, 2016

True, I was not asked to fill out a satisfaction survey after surgery at Vancouver General. Not much paperwork. True also, the government does not control which physician I got to see, although a primary care physician sent me to a specialist.

The thing with the US is unlike in Canada (at least BC which is my familiarity), the hospitals not government run. Does this contribute to the paperworks

NurseFifty · May 31, 2016

Also true, the equivalent of the US SSN is the SIN in Canada.

pmabraham, BSN, RN · May 31, 2016

You seem to want to play both sides of this debate, which just cannot happen.

Incorrect. I believe in direct relationships. In healthcare, to me that one day means doctors and other healthcare providers can have direct relationships with their patients without a single insurance company having anything to say about what both (provider and patient) think is best for the patient. I don't believe that can be accomplished through insurance which can be rejected; and, since taxpayer money is a finite resource, there's no offer large enough for an insurance company to make that will guarantee acceptance. So I like the idea of cash vehicles whereby the patient is in control over their healthcare vs. a government.

MunoRN, RN · May 31, 2016

BC MSP claims it does send its heart patients to the US

Everything I can find from them says that they do their own heart surgery. I've worked at hospitals just across the border, and sent canadian residents up to BC for surgery, which wouldn't make a lot of sense if they are just going to send the patient back to the US, I've also gotten US citizens transferred to us who just had open heart done in BC. It used to be you had to go to the greater Vancouver area to have it done in BC but even that isn't true anymore. Open heart surgery program begins in Interior Health | BC Gov News

Canada has about 1 cardiac surgeon per 100k population, about the same as the rest of the world.

MunoRN, RN · May 31, 2016

Incorrect. I believe in direct relationships. In healthcare, to me that one day means doctors and other healthcare providers can have direct relationships with their patients without a single insurance company having anything to say about what both (provider and patient) think is best for the patient. I don't believe that can be accomplished through insurance which can be rejected; and, since taxpayer money is a finite resource, there's no offer large enough for an insurance company to make that will guarantee acceptance. So I like the idea of cash vehicles whereby the patient is in control over their healthcare vs. a government.

The majority of healthcare costs, and the services being paid for, can only really be fully paid for through some sort of cost pooling (insurance). In order to make all healthcare services payable as individuals without cost pooling, we would have to stop providing these other services, such as acute hospitalizations for various life threatening conditions, dialysis, cancer treatment, etc. Does that really sound like a better system to you?

heron, ASN, RN · May 31, 2016

The majority of healthcare costs, and the services being paid for, can only really be fully paid for through some sort of cost pooling (insurance). In order to make all healthcare services payable as individuals without cost pooling, we would have to stop providing these other services, such as acute hospitalizations for various life threatening conditions, dialysis, cancer treatment, etc. Does that really sound like a better system to you?

Alternatively, are you willing to quietly die if you can't afford to pay an EMS crew or 24/7 nurses?

It would take one monster HSA, even if you halved costs like wages, supplies, technology, etc.

DoGoodThenGo · May 31, 2016

Incorrect. I believe in direct relationships. In healthcare, to me that one day means doctors and other healthcare providers can have direct relationships with their patients without a single insurance company having anything to say about what both (provider and patient) think is best for the patient. I don't believe that can be accomplished through insurance which can be rejected; and, since taxpayer money is a finite resource, there's no offer large enough for an insurance company to make that will guarantee acceptance. So I like the idea of cash vehicles whereby the patient is in control over their healthcare vs. a government.

With all due respect do not believe you understand how single payer health care schemes work, nor governments for that matter.

First of all no, taxpayer funding is not "finite". Governments including the USA have a vast and bewildering array of ways to raise revenue via taxes, levies, fees, surcharges, etc.... People may grumble about the amounts and so forth, but that is another matter.

Just giving funds to persons that they have not earned is called something in this country" welfare. That alone is enough to sink any such HSA as you propose for a start. You want to put your own money into such an account, that is something people can live with; but just giving every man woman and child one million or so dollars yearly? No, that is not going to happen.

HSA are not very efficient for a government because you are giving persons money regardless of actual need. My personal total healthcare spending for 2015 came to barely two grand, and much of that was from insurance costs. So what would I have done with one million sitting in the bank I otherwise cannot use? I'll tell you what; same thing economists have proven human nature is want to do; find ways to spend that "free" money even if it isn't required. Multiply that by hundreds of millions of persons in the USA and you are talking about a huge economic waste of scarce funds.

Every single payer healthcare scheme has in place someone or something that is meant to control costs. The extent they "interfere" or "come between" physician and patient varies. It could range from a doctor refusing to write a script for a brand name drug when a generic will suffice, to a decision being made when to end aggressive treatment of a mortal disease and move to hospice/ palliative care.

This comes for a reason; while governments can raise vast sums for general revenue none can or are willing to see healthcare consume ever increasing portions of GDP to the point it becomes the majority if not dominate drain upon the treasury.

The USA has one of if not the highest rate of healthcare spending in the world with far less to show for it than other countries. Countries such as France, GB, Italy, Germany, Japan, etc... all spend less of their overall GDP on health but by many metrics (infant mortality, cancer survival rates, etc...) do far better than the USA.

Giving persons money is just another blank check to encourage what is wrong with the USA healthcare system; it is driven not by quality of care but by the number and frequency of things being done to or for patients.

Closest thing to what you seem to want is the NHS of GB. National Health Service (England - Wikipedia, the free encyclopedia)

Health care spending compared to other countries | The King's Fund

DoGoodThenGo · Jun 1, 2016

Average cost of just one severe incident such as a heart attack, high risk pregnancy, birth and subsequent infant/mother care can easily go > one million dollars. Then what? Do you tell that HSA account holder "tough cheese" you'll have to wait until your next yearly deposit?

Then you have those requiring or have had transplant surgery, long term chronic illnesses such as HIV/AIDS or hepatitis, organ failure, cancer, etc... One million per year won't go very far, and again what happens when that money runs out?

Individual HSA accounts also would turn everyone into essentially uninsured patients. As such they would lack the bargaining power that comes from being a member of an insured pool. As noted in linked article posted above hospitals (and often physicians) have vastly different rates for the same procedure/illness. Worse those who are uninsured usually are charged higher rates than those who have insurance. This is usually because the uninsured lack the discount that comes from being a member of a negotiated pools.

pmabraham, BSN, RN · Jun 5, 2016

The majority of healthcare costs, and the services being paid for, can only really be fully paid for through some sort of cost pooling (insurance). In order to make all healthcare services payable as individuals without cost pooling, we would have to stop providing these other services, such as acute hospitalizations for various life threatening conditions, dialysis, cancer treatment, etc. Does that really sound like a better system to you?

1. There are a number who pay by cash. There are doctors and hospitals that charge less when one pays cash.

2. No, it doesn't sound like a better system. A better system to me would be the smallest government possible to guarantee our constitutional rights, the only insurance that would exist (if any) would be to cover catastrophic events, and we would have a direct provider to patient relationship where no payment provider would have a single say as to what's best for the patient.

heron, ASN, RN · Jun 5, 2016

IOW, if you're not rich enough to pay cash, you deserve to die.